Thyroid eye disease causes the muscles and soft tissues within the eye socket to swell. This pushes the eyeball forward and causes various eye symptoms. Treatment involves steps to protect the eye as the disease runs its course. This may involve artificial tears, medicines and, in some cases, surgery. Thyroid eye disease is usually associated with an abnormality of thyroid gland function. This also needs to be treated.TED is sometimes called other names such as thyroid ophthalmopathy, dysthyroid eye disease, Graves’ ophthalmopathy or ophthalmic Graves’ disease.
Who gets thyroid eye disease?
This is a rare condition affecting about 16 women in every 100,000 people and 3 men in every 100,000 people each year. Most of these people have a problem with an overactive thyroid gland and have an underlying autoimmune condition. It generally occurs in middle age. Some people carry genes that make it more likely that they will get thyroid eye disease. It is also more likely to develop if you smoke.
What are the symptoms of thyroid eye disease?
Symptoms are caused by the tissues of the eye socket swelling and pushing the eyeball forward:
- Redness and Irritation in the eye
- Pain and dryness
- Your eyes may look more bulgy, giving you a staring appearance.
- You may get double vision (diplopia) as the muscles become too swollen to work properly.
- In advanced disease, your vision may become blurred and colors can appear less vivid.
The two eyeballs are not always equally affected. You may have other non-eye symptoms due to the abnormal thyroid gland.
How is thyroid eye disease diagnosed?
Diagnosis can be made simply by examining your eyes if you already have a diagnosis of a thyroid gland problem. Eyes have a classic Staring look, also there is a noted bulge, restriction of ocular movements, congestion etc.
Sometimes, blood tests are needed to back up the diagnosis. They look at how well the thyroid gland is functioning by measuring its chemical messengers (hormones) in your bloodstream. These are called thyroid function tests (TFTs). More specialized blood tests can be done to measure the antibodies in your blood.
Occasionally, thyroid scans need to be done to see how actively the thyroid gland is working (uptake scans). If the doctors are particularly concerned about the swelling in the orbit, they may organize a scan (known as an MRI) which will show up which tissues have been most affected.
Doctors will want to assess your general sight carefully, including how well you see colors and how good the vision out of the corner of your eye (your peripheral vision) is. They may also want to carry out an eye movement test to see how much the muscles have been affected. These assessments will be repeated throughout the course of the disease.
What is the treatment for thyroid eye disease?
This is a self-limiting disease: if left untreated, the inflammation will gradually go by itself. But, the symptoms caused by the swelling (such as bulging eyes) may remain, as some of the tissues that have been stretched may not always be able to return to their original form. The aim of treatment is mainly to limit damage occurring during the inflamed period. There are also treatments for people whose tissues have not been able to return to their original form after the inflammation has settled. The eye problems will be managed by an eye doctor (ophthalmologist) and the underlying thyroid problem by your own doctor or by a specialist in the hormone systems of the body (an endocrinologist).
Is there anything I can do?
Yes. Here are a few tips:
- We know that one thing that makes this disease worse is smoking. If you do smoke, please stop smoking.
- Sleeping propped up will help reduce the puffiness (congestion) around the eyes.
- Lubricants and decongestant drops can be used to reduce symptoms of irritation.
- If you may find bright light uncomfortable, wear sunglasses
- Stop driving ,if you have double vision.
Are there any complications from thyroid eye disease?
Most people do not develop permanent complications. However, they do occur in some people, especially those where treatment is delayed or where the TED has been severe. They are also more likely in older people, in those who smoke and in people with diabetes. Possible complications from the disease include:
- Damage to the cornea due to exposure.
- Permanent squint or double vision.
- Damage to the nerve of the eye, resulting in poor vision or color appreciation.
- Unsightly appearance.
What is the outlook (prognosis) for thyroid eye disease?
This is a drawn-out illness. The inflamed period tends to last months to years (usually about two years). However, for most people it will be a mild disease needing lubricants and regular assessments only. It ‘burns out’ (fades away) by itself.
For those with more severe disease, the outlook depends on how early it is diagnosed and how intensive the treatment is. About 1 in 4 people will end up with reduced eyesight.